Using virtual patients to improve cardiac examination competency in medical students

Area of Science:

• Medical Education
• Cardiology
• Clinical Skills Training

Background:

• Cardiac examination (CE) skills are declining, with prior studies limited by focusing solely on auscultation via audio recordings.
• Virtual patient examinations (VPEs) were developed using interactive multimedia of patients with visible and audible cardiovascular findings to address these limitations.

Purpose of the Study:

• To evaluate the effectiveness of VPEs in improving CE skills.
• To determine if improvements in CE skills are retained over time.
• To assess competency in overall CE and specific categories: inspection, auscultation, knowledge, and integration of visual and auditory skills.

Main Methods:

• A cohort of 24 medical students received supervised instruction with VPEs (intervention group).
• A control group of 58 students received standard Internal Medicine clerkship instruction without supplemental CE training.
• Both groups were tested at the beginning and end of their rotations, with the intervention group re-tested 14 months later.

Main Results:

• The intervention group showed significant improvement in overall CE scores (58.7 to 73.5, p=0.0001) and in inspection, auscultation, and knowledge (p≤0.02).
• The control group showed no significant improvement in overall scores (60.1 to 59.5, p=0.788).
• Re-testing 14 months later showed further improvement in the intervention group (to 83.6, p=0.004), while the control group's improvement was not significant (p=0.464).

Conclusions:

• VPEs effectively improved cardiac examination inspection, auscultation, and knowledge to the level of cardiology fellows.
• Skills acquired through VPEs were retained for at least one year.
• VPEs serve as valuable teaching and testing tools, identifying specific CE skills requiring further training.